Pregledni rad
NEUROPATHIC PAIN IN HEADACHES
DAVOR JANČULJAK
; Klinički bolnički centar Osijek, Klinika za neurologiju Osijek i Sveučilište Josipa Jurja Strossmayera u Osijeku, Medicinski fakultet, Osijek, Hrvatska
Sažetak
The most common origin of neuropathic pain in the head are orofacial neuralgias; they appear mostly in the lower facial parts of the head and in the oral cavity, rarely in the upper part of the head as the main location of pain in headache disorders. Only a small proportion (4%) of patients with trigeminal neuralgia have symptoms in the supraorbital region. The fi rst choice of drugs to treat pain in trigeminal neuralgia are anticonvulsants (carbamazepine and oxcarbazepine), followed by muscle relaxants (baclofen) and pimozide (a neuroleptic drug) in most severe cases. In drug resistant cases, either conventional surgery or gamma-knife surgery may be indicated to treat pain. Differential diagnosis has to be made to distinguish both idiopathic and classical trigeminal neuralgia from symptomatic neuralgias (post-herpetic), fronto-orbital neuropathies (post-traumatic, ophthalmoplegic) and primary headaches (idiopathic stabbing headache, nummular headache). In some cases, trigeminal neuralgia may co-occur with primary headaches (syndromes labeled as cluster-tic syndrome, paroxysmal hemicrania-tic syndrome, and hemicrania continua-tic syndrome). Neuropathic pain may be evoked by central sensitization in primary headaches like migraine and tension-type headache causing allodynia and hyperalgesia along with the usual clinical presentation of classical nociceptive and specifi c neurogenic pain. Early intervention with triptans at the beginning of migraine attack is the best way to prevent central sensitization and avoid allodynia. Central neuropathic pain occurring in the head region is caused by a lesion or dysfunction in the central nervous system (stroke, multiple sclerosis).
Ključne riječi
neuropathic pain; trigeminal neuralgia; headache
Hrčak ID:
224648
URI
Datum izdavanja:
14.7.2019.
Posjeta: 3.636 *